Veteran’s Responsibilities Form
Please Read Carefully, Initial Each Section , and then Sign Below
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You must register in courses that are required for the degree/certificate program you have selected. The
Department of Veterans Affairs only pays for courses which are part of an approved degree/certificate
program, and have not been previously and successfully completed. Please refer to your Degree Audit
Program (DARS) report and/or contact your Academic Counselor to be certain the classes you are taking
will apply towards your degree. You must submit a copy of your class schedule along with your GI Bill
Certification Form to the Tri-C VA Office in order to be certified for education benefits.
If you adjust your class schedule then you must report these adjustments to the Tri-C VA Office
immediately. Federal law requires you to report any change in your enrollment status that might affect
your VA education benefits. Once you submit a copy of your schedule along with a certification form, it is
your responsibility to notify the office of any changes in status. This includes alterations to class schedule,
change of major, and change of address. Changes should be reported to avoid delay in payments or
possible overpayments. Changes in enrollment after the last day to drop and add courses may result in the
retroactive loss of benefits unless mitigating circumstances were involved in the change. If mitigating
circumstances exist, proof of said circumstances must be on file with the Tri-C VA Office. Loss of benefits
could revert back to the first day of class.
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Chapter 30, 1606 and 1607 students must verify their enrollment with the VA on the last day of each
month before payment is released to you. Payments are disbursed from the VA, not Tri-C. Verification
phone number is 1-877-823-2378 OR on the web at www.gibill.va.gov. The first time you verify, your
password is the last six digits of your SSN, and your file number is your whole SSN.
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You must provide to the college, official copies of transcripts from all previously attended colleges and
universities for transfer evaluation. Failure to submit all previously attended college and university
transcripts will result in future semesters not being certified with the VA. You should also consider
ordering your AARTS or SMARTS transcripts to receive college credit for military training.
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The Enrollment Center will make special hold arrangements for students who receive Ch.33 (Post 9/11 GI
Bill) benefits only. If Tri-C applies a hold in anticipation of future VA payments to your account and
the VA does not make a payment because you do not have sufficient benefits, you are obligated to settle
your student balance prior to the end of the term and the release of your transcripts. Failure to submit
residency paperwork to change from out-of-state tuition rate to in-county/out-of-county tuition rate per
the State of Ohio’s “GI Promise”, you will be responsible for the balance with the college. You are
responsible for monitoring your student account.
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If an instructor reports you as never attended, the veteran’s hours will be reduced retroactively to the first
day of classes. If an instructor annotates on the final grade sheet a “WF”, a withdrawal with punitive
grades will be reported to the VA, along with your last date of attendance.
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For students who currently serve in the military and will miss classes for short-term military training
exercises, we recommend that you contact your instructors as soon you become aware and provide them
with a copy of your orders. This will allow time for appropriate arrangements to be made.
My signature indicates I have read and understand my responsibilities. I am responsible for knowing
guidelines and regulations within this form.
Student Signature: ____________________________________________________________________________
Student ID: S ____________________________________Date _______________________________________
GI-BILL CERTIFICATION FORM
ALL students must provide a Certificate of Eligibility and a copy of your schedule when turning in this form
TERM: Fall Spring
Summer
YEAR:___________
NAME: ________________________________________________ TRI-C STUDENT #
S______________________________________
ADDRESS: _____________________________________________ CITY:___________________________ZIP:______________
MAIN PHONE NUMBER: _______________________________
COUNTY: Cuyahoga / Out of County ADDRESS CHANGE: YES / NO
PROGRAM OF STUDY: _________________________________ PREVIOUS COLLEGES ATTENDED_________________________________
(Certifications will be processed based on your program of study officially on record – information above will be used to update your record)

Applicant Type
Check only one:
Continuing – last VA payment at Tri-
Additional Required Forms
ALL students must provide a Certificate of Eligibility and a copy of your schedule
C

Transfer- last VA payment at another

school

New –no prior VA payments


Guest/Visiting

MUST complete Change of Training Place Form - VA22-1995 or VA22-5495 and
submit with this form
MUST apply online for VA benefits – VA22-1990 and submit COE upon receipt
with this form
MUST submit a Transient Form from your home school with this form
School Name:
VA
Benefit
Type



Chapter 31 – Vocational Rehab
Chapter 33 – Post 9/11 GI Bill
Chapter 30 – GI Bill
(___Advance Pay?)



Chapter 35 – Dep/Survivor File#
Chapter 1606 – Selected Reserve
Chapter 1607 - REAP
FINANCIAL ASSISTANCE I am receiving in addition to VA educational benefits:
 ONG (Ohio National Guard) Scholarship Program
 Employer waiver/reimbursement
 Federal Tuition Assistance
 Scholarships
 MyCAA
 Other __________________________________________
 Go Army Ed
You may incur a debt, your certification may not be processed for classes enrolled, your paperwork may be terminated or not
processed if ONE of the following applies:
*Discrepancy with program of study (program listed with the VA office conflicts with program of study declared on My Tri-C Space)
*Enrolled in classes that are not required for your declared program of study (ex. PE courses)
*Receive a punitive grade for unofficial withdrawal of course(s)
*Dropping or auditing a course
*Repeating courses already successfully completed
*Not registered for courses
*Stop attending courses
*Adjusting your class schedule (adding or dropping courses after turning in a copy of your class schedule)
*Failure to submit residency paperwork to change from out-of-state tuition rate to in-county/out-of-county tuition rate
*Failure to submit official transcripts from all institutions attended for evaluation of transfer credit
You should understand the following:
*Changes to any of the information above requires me to notify the Tri-C VA office at once
*It is my responsibility to submit a certification form and a copy of my schedule each semester
*I am responsible for checking my Tri-C email account. All VA related correspondence will be via my Tri-C email account
By signing below, I acknowledge I have read this complete form and I understand and agree to the policies and
procedures on receiving my VA educational benefits through the Tri-C VA Office. I accept responsibility for all debts
owed to Tri-C and to the US Dept. of Veterans Affairs under the terms and conditions stated on this form.
Student Signature____________________________________________________ Date ______________________________
**************IMPORTANT************
Per VA – processing time could take up to 4 - 6 weeks from the time you turn in your Certification Form. Be financially prepared
ahead of time while waiting to receive your benefits. Requests are processed in order received.